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Congress should crack down on Medicare Advantage health plans for seniors that sometimes deny patients vital medical care while overcharging the government billions of dollars every year, government watchdogs told a House panel. Read more»

After paying more than $9,000 in premiums and fees over 13 months to O’NA HealthCare, Jill Goodridge says, she could not get O’NA to cover her family’s medical bills. Frustrated, the Rockland, Maine, resident complained to state regulators in summer 2018. “It almost seemed like we were just spending the premium money every month for really not much,” she says.

O'NA HealthCare claimed Native American tribal affiliation to entice customers and avoid federal oversight. Read more»

The Justice Department has joined a California whistleblower’s lawsuit that accuses insurance giant UnitedHealth Group of fraud in its popular Medicare Advantage health plans. Read more»

Medicare pays the privately run health plans — an alternative to traditional Medicare — a set monthly rate for each patient. About 16 million Americans have signed up at an annual cost to taxpayers of more than $160 billion, about one third of the elderly and disabled people eligible for Medicare. A Center for Public Integrity investigation published in June found as much as $70 billion of improper payments to Medicare Advantage plans from 2008 through last year. Read more»

Critics warned of billing abuse in Medicare Advantage health plans, but oversight is lagging. Read more»

Q & A with Center for Public Integrity reporter Fred Schulte. Read more»

Josh Valdez, former health official under George W. Bush.

Company says former Bush health official simply a "disgruntled employee." Read more»

Humana Inc. faces multiple federal investigations into allegations that it overbilled the government for treating elderly patients enrolled in its Medicare Advantage plans, court records reveal. Read more»

Center analysis and American Hospital Association

Federal officials for more than a decade have let hospitals decide on their own how much to charge Medicare for certain emergency room overhead and staffing costs called “facility” fees — a controversial policy some critics believe invites overcharges. Now in a major turnabout, the Centers for Medicare and Medicaid Services are seeking tighter controls over the fees as part of a plan to redirect billions of dollars Medicare spends annually on outpatient health care. Read more»

The Department of Health and Human Services headquarters by the National Mall.

Citing massive budget and staff cuts, federal officials are set to scale back or drop a host of investigations into Medicare and Medicaid fraud and abuse — even though cracking down on government waste and cutting health care costs have been top priorities for the Obama administration. Read more»

Farzad Mostashari, MD, National Coordinator

The Obama administration is forging ahead with a multi-billion dollar plan to shift from paper to electronic medical records, despite continuing concerns the program may be prompting some doctors and hospitals to improperly bill higher fees to Medicare. Read more»

The agency's crippled oversight of the industry means troubled gun dealers can stay open for years. Some don’t see an inspector for eight years or more. By law, ATF can inspect dealers once a year only and may revoke a license only when it believes the dealer “willfully” violated gun control laws. Read more»

The root of these increases are controversial charges known as "facility fees," and they are routinely tacked on to patients’ bills not just for services actually provided in hospitals, but also by outpatient care centers and doctors’ offices simply because they’ve been purchased by hospital-based health care systems. Read more»

Dr. Farzad Mostashari is the National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services.

The nation's top health information technology official has launched an internal review to determine if electronic health records are prompting some doctors and hospitals to overbill Medicare. Read more»

Dozens of Barack Obama's elite donors have been appointed to advisory panels and commissions that can play a role in setting government policy. Others have been invited to a range of exclusive White House briefings, holiday parties and splashy social events. Read more» 1

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